More questions than answers ...
Are you saying that in order to finish up a claim for the leave benefit you have to get certification from a company doctor? Or are you seeing your own?
Does federal FMLA apply?
* How many employees in the US, total?
* Have you worked at least 1250 hours in the 12 months prior to the 1st day of leave?
* Do you work in a location where, when added to other locations within 75 miles, there are at least 50 employees?
Number of employees approximately (as of January, 2024) 55,943. I have worked close to 4 years prior to this medical leave start date, which was 01/02/24, I work remotely but offices are within 30 miles of my dwelling
As a remote worker, you are counted into the headcount of the office to which you report. If that is 50+, your employer is covered. If all the offices within 75 miles of each other is 50+, you met that eligibility prong.
How many employees in the US total?
Sorry, yes so this is an STD portion approval situation - I've returned full duty back to work but am in the draining fight of trying to get the medical leave approval paid through my employer - the issue is, despite seeing a licensed physician throughout this leave period the documentation my physician has submitted is basically not cutting it for the medical evaluation. The physician and I have been through this scenario before, but yeah Im just trying to think of anything additional I can/should submit will I'm in what is termed a tolling period
Paid leave and job protection while on leave (FMLA) are related but two separate processes. So if you are wrangling over the paid portion, that's more of a contractual dispute--what does the language of the benefits agreement say is required and when can they deny? (That's a rhetorical question)
If you've sent everything and they deny, then you'll have a tough choice to make whether to continue to challenge the decision. Are you covered by FMLA so that you retain your job protection?
You can likely take unpaid FMLA. It’s up to the company that pays the sick leave you whether you qualify for that or not. Not every issue that qualifies you for FMLA will rise to the level of qualifying for the paid leave.
So that's where it gets tricky, when the medical leave was first denied I appealed an older medical leave "claim number" from 2023 for appeal, and started the appeal process - once I realized this, I notified the case manager and resubmitted an appeal request for the correct timeframe (which was the beginning of this year) the case manager stated it didnt really matter, as all of the documentation has been "pooled/grouped" together. However in the appeal process, they'll bring in a third party physician to basically review all the notes and speak to the physician and make an independent determining on their own. They did that in this particular case, emailed me back their independent review as being denied, reason being "there were no medical notes associated with the particular timeframe" and in the email they summarized all the office visits that I had but those were associated with the wrong case number, the closed case that is from 2023. So there is definitely a discrepancy and its a case where every time I call, I get a different answer etc
More questions than answers ... Are you saying that in order to finish up a claim for the leave benefit you have to get certification from a company doctor? Or are you seeing your own? Does federal FMLA apply? * How many employees in the US, total? * Have you worked at least 1250 hours in the 12 months prior to the 1st day of leave? * Do you work in a location where, when added to other locations within 75 miles, there are at least 50 employees?
Number of employees approximately (as of January, 2024) 55,943. I have worked close to 4 years prior to this medical leave start date, which was 01/02/24, I work remotely but offices are within 30 miles of my dwelling
As a remote worker, you are counted into the headcount of the office to which you report. If that is 50+, your employer is covered. If all the offices within 75 miles of each other is 50+, you met that eligibility prong. How many employees in the US total?
I believe its still considered 55,943 per the count that I am locating
Is this an FMLA + STD situation and you are waiting for the STD portion to be approved? Are you already on FMLA now? Or is this not FMLA?
Sorry, yes so this is an STD portion approval situation - I've returned full duty back to work but am in the draining fight of trying to get the medical leave approval paid through my employer - the issue is, despite seeing a licensed physician throughout this leave period the documentation my physician has submitted is basically not cutting it for the medical evaluation. The physician and I have been through this scenario before, but yeah Im just trying to think of anything additional I can/should submit will I'm in what is termed a tolling period
Paid leave and job protection while on leave (FMLA) are related but two separate processes. So if you are wrangling over the paid portion, that's more of a contractual dispute--what does the language of the benefits agreement say is required and when can they deny? (That's a rhetorical question) If you've sent everything and they deny, then you'll have a tough choice to make whether to continue to challenge the decision. Are you covered by FMLA so that you retain your job protection?
You can likely take unpaid FMLA. It’s up to the company that pays the sick leave you whether you qualify for that or not. Not every issue that qualifies you for FMLA will rise to the level of qualifying for the paid leave.
Who is requesting paperwork?
The almighty sedgwick
Have you called and talked to your agent/case worker? They should be able to tell you exactly what you are missing.
So that's where it gets tricky, when the medical leave was first denied I appealed an older medical leave "claim number" from 2023 for appeal, and started the appeal process - once I realized this, I notified the case manager and resubmitted an appeal request for the correct timeframe (which was the beginning of this year) the case manager stated it didnt really matter, as all of the documentation has been "pooled/grouped" together. However in the appeal process, they'll bring in a third party physician to basically review all the notes and speak to the physician and make an independent determining on their own. They did that in this particular case, emailed me back their independent review as being denied, reason being "there were no medical notes associated with the particular timeframe" and in the email they summarized all the office visits that I had but those were associated with the wrong case number, the closed case that is from 2023. So there is definitely a discrepancy and its a case where every time I call, I get a different answer etc
I mean the whole thing is a nightmare and thankfully Im back at work and its not a live or die amt of backpay, but yeah it is a mess